My doctor thinks im not taking my medication

[akela1975]

My doctor thinks im not taking my medication but i taking it every morning

My results

Serum free t4 level - 20.6 pmol/l (10.00 - 18.70pmol/l)

Serum tsh level 9.56 mu/l (0.56 - 4.78mul/l)

But i still on 250mg of levo any help would be great

[SlowDragon Administrator]

As a chap, you may simply need a higher dose.

But you may not be converting FT4 to FT3 very well. It's essential to test FT3

Do you know if you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies?

Low vitamin levels are extremely common when hypo. Low stomach acid too

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies.

Plus very important to test vitamin D, folate, ferritin and B12

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, don't take in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

When do you take your Levothyroxine?

Always take Levo on empty stomach and then nothing apart from water for at least an hour after.

Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription. (Watch out for brand change when/if dose is increased)

What are your main symptoms

Do you take any vitamin supplements, if so what exactly

[akela1975 in reply to SlowDragon]

Ok all ive been told 10 yrs ago is i have an underactive thyroid take this tablets

I take 250mg every morning at 6.30am then in the evening i tskr multi-vitamin from Sainsbury's and turmeric from h/b

[diogenes Remembering]

If the FT4 is as you say and you are faithfully taking the tablets, then the FT4 value is in harmony and backs you up. Therefore if TSH is still as high as this on that amount of T4, it can't be a matter of poor absorption (decent FT4, so rule that out) and is more likely to be a matter of resistance or conversion. This means you need your FT3 as well to get an idea of conversion as well. A FT4/FT3 ratio of say about 5/1 would indicate conversion problems, and a ratio in the 3/1 region would indicate resistance. This if true would mean you need FT4 and FT3 above what most people would regard as normal.

[greygoose in reply to diogenes]

If she had a resistance problem, would it cause a high TSH like that? I thought it would just cause high levels of serum T3 with hypo symptoms. But, if the FT3 is high, surely the TSH would be low, no?

[diogenes Remembering in reply to greygoose]

If there is resistance it can happen at many levels. However it is most likely that the problem if it exists is somewhere in the pituitary's sensitivity to T4 and T3.

[greygoose in reply to diogenes]

OK, thank you.

[Angel_of_the_North]

Well, you wouldn't have a high FT4 like that if you weren't taking it. I'd want to know why the TSH is so high when FT4 is good. So need FT3 test and tests for TSH-secreting adenoma. Or were you taking a B vit or hair and nails supplement containing biotin before test?

[akela1975 in reply to Angel_of_the_North]

I was taking multi vitamin with b12 in t

[Angel_of_the_North in reply to akela1975]

Does it have biotin, sometimes called B7?

[SlowDragon Administrator]

Multivitamins are not usually recommended on here , too little of what we actually need and stuff we don't

greygoose can explain about multivitamins

As Angel_of_the_North points out - biotin in any supplements can sometimes falsely affect test results

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Ask GP to test vitamin D, folate, ferritin and B12 (make sure to stop multivitamins a week before)

Also ask that they repeat your TSH, FT4 and include FT3 and both TPO and TG Antibodies

Lab may still not do FT3 or antibodies even if GP requests, in which case will need to do privately

Come back here with results on a new post

[greygoose]

You shouldn't be taking a multivitamin anyway for all sorts of reasons.

* If your multi contains iron, it will block the absorption of all the vitamins - you won't absorb a single one! Iron should be taken at least two hours away from any other supplement except vit C, which is necessary to aid absorption of iron, and protect the stomach.

* If your multi also contains calcium, the iron and calcium will bind together and you won't be able to absorb either of them.

* Multi's often contain things you shouldn't take or don't need : calcium, iodine, copper. These things should be tested before supplementing.

* Multi's often contain the cheapest, least absorbable form of the supplement : magnesium oxide, instead of magnesium citrate or one of the other good forms; cyanocobalamin instead of methylcobalamin; folic acid instead of methylfolate; etc. etc. etc.

* Multi's do not contain enough of anything to help a true deficiency, even if you could absorb them.

With a multivitamin, you are just throwing your money down the drain, at best, and doing actual harm at worst. Far better to get tested for vit D, vit B12, folate and ferritin, and build up your supplementation program based on the results.

[akela1975]

Thanks i will stop taking multi

How long clear should i be before i test vit d and b12

Same how long before ishould do a retest of my thyroid